Provider Demographics
NPI:1003436759
Name:CREATING SPACE, LLC
Entity Type:Organization
Organization Name:CREATING SPACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-205-8205
Mailing Address - Street 1:1915 WINNEBAGO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5322
Mailing Address - Country:US
Mailing Address - Phone:608-205-8205
Mailing Address - Fax:608-999-7313
Practice Address - Street 1:1915 WINNEBAGO ST STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5322
Practice Address - Country:US
Practice Address - Phone:608-205-8205
Practice Address - Fax:608-999-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty